Healthcare Provider Details

I. General information

NPI: 1740633510
Provider Name (Legal Business Name): ANGELICA KOZLOWSKI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 06/04/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 PFINGSTEN RD. SUITE 3000
SKOKIE IL
60077-1057
US

IV. Provider business mailing address

2180 PFINGSTEN RD. SUITE 3000
SKOKIE IL
60077-1057
US

V. Phone/Fax

Practice location:
  • Phone: 847-503-3000
  • Fax: 847-503-3500
Mailing address:
  • Phone: 847-503-3000
  • Fax: 847-503-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20914474
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014474
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209014474
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: